Recent legislation, such as P.L. 99-457, mandates special health and education services for "at-risk" children. Rigorous studies of the long- term benefits of such services are needed. The Infant Health and Development Program (IHDP) is an on-going multicenter, randomized, controlled trial to test the efficacy of an intervention (educational and family supported services) during the first three years of life in reducing the incidence of health and developmental problems among a group of "at- risk" children, low birthweight (LBW) premature infants. At age 3, the intervention has resulted in significant reductions in cognitive and behavioral problems. The goal of the proposed research is to see whether, and for what subgroups, the benefits of this intervention continue into the elementary school years. A total of 985 LBW premature infants from 8 clinical centers were enrolled into the IHDP during the period October, 1984 to August, 1985. They were randomly assigned to an intervention (INT) group (n = 377) or to a control (FU) group (n = 608). The INT group received pediatric follow-up together with educational and family services via home visits from birth to Age 3 and attended Child Development Center schools for Ages 2 and 3. The FU group received only pediatric follow-up with referrals, as necessary, to community resources if serious developmental or other problems were detected. At Age 3, completed assessments were obtained for 93% of those enrolled. These data show that members of the INT group had significantly and consistently higher IQ mean scores (9 points, Stanford-Binet) and significantly lower behavioral problem scores (35 points, Achenbach Child Behavior Checklist). Continued follow-up of the cohort through Ages 4 (91% follow-up) and 5 (underway) includes annual assessments of health status, family functioning, and use of child care and other services. At Age 5, blinded cognitive and behavioral assessments also are being made. This proposal requests funding for further follow-up and analysis of the cohort. Assessments of health status, family functioning, and use of services at Ages 6 1/2 and 8 are proposed; in addition, assessments of cognitive functioning, school performance, emotional functioning, and social competence are proposed at Age 8 together with information on maternal, home, and neighborhood mediating characteristics. This will permit determination of whether the outcome enhancement for LBW premature infants achieved at Age 3 persists into the elementary school years. Correlates (initial status as well as time dependent measures) of any long- term effects observed, or of effects present at Age 3 but no longer present will be sought in order to clarify mechanisms and to determine predictors of long-term outcomes.